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W.H.O. UPDATE ON ELIMINATION OF LEPROSY
THE FUTURE OF LEPROSY TRAINING AND RESEARCH INSTITUTIONS
ALERT HOSTS MAJOR MEETING IN ADDIA ABABA (excerpts from WHO's "LEP/NEWS Vol.7, No.1, May 1998:- Doctors, scientists and managers from over 20 institutions in five continents attended a meeting in Addis Ababa from 25th. to 26th. February 1998, to discuss the future role of leprosy training and research institutions. The Meeting was hosted by ALERT, the 34-year old anti-leprosy training centre for Africa, based in the Ethiopian capital and was chaired by Dr. Joseph Kawuma, Deputy Director of the Ugandan National TB/Leprosy Programme. Participants reviewed the current activities of specialised leprosy institutions in the light of changing needs, sought to identify feasible activities during the next ten years, and examined the likely training and research needs in the future.
A key paper was read on behalf of Dr. R.R. Jacobson, Director of National Hansen's Disease Programs at the G.W. Long Hansen's Disease Center in Carville, Louisiana, who was unable to attend in person. He mentioned first that, contrary to rumours, Carville is not closing but is being relocated to Baton Rouge, and the center will remain an active department of Louisiana State University. Dr. Jacobson argued that leprosy will be with us long after the year 2000 and some expertise must be maintained in many areas beyond that date. Future activities will depend on the workload, but the disease should continue to be extensively covered in all medical and para-medical training and in the appropriate textbooks. The general public also should be kept informed about leprosy through the mass media.
Dr Jacobson suggested that countries with more than, say, 100 new cases per year, might consider maintaining regional experts and a referal facility (probably part of a general hospital) for in-patient care of complicated cases. Countries with more than 1000 cases per year would need more than one referral centre, and their whole programme should be regionalized under national guidelines. Such a situation already exists in the U.S.A., he added, and it could be a useful model for other low-endemic countries. Dr Kawuma's own presentation looked at the relationship betweeen institutions and natuional programmes. There are suignificant areas of over-lap in both objectives and activities, he said, although they have different expertise and constraints. Even when leprosy has been eliminated and control activities have been integrated into general health services, many activities will benefit from having active institutions in place. Training should be better focused towards the needs of the national programme, and since programme managers are not usually in a position to undertake basic research, a sound research institution will still be needed.
W.H.O.'s ACTION PROGRAMME ON THE ELIMINATION OF LEPROSY,
Director Dr S.K. Noordeen, suggested that, while general health staff are not at all reluctant to treat leprosy patients, there is a tendency for personnel trained in leprosy work to show reluctance to hand over such work to them. Among the recommendations to merge from the meeting, it was underlined that, in view of the rapidly changing situation of leprosy and the increasing integration of leprosy work within the general health services, the role of leprosy training and research institutions needs to be re-defined. The essential roles of training, service and research should be retained but with renewed focus on elimination and post-elimination issues. There remains a need for continued research into improving patient care as well as for operational research, and basic research in leprosy should be maintained.
LEPROSY IN THE SOUTH-EAST ASIA REGION
OPTIMISM IN THE REGION WITH THE HEAVIEST BURDEN (excerpts from WHO's "LEP/NEWS.. May 1998):- Among the five countries with the largest number of leprosy cases in the world, four are in the W.H.O.'s S.E. Asia Region. Bangladesh, India, Indonesia and Myanmar account for some 70% of the global registered cases, and India alone, contributes nearly 55% of the total. Every year in the region, about 400,000 new cases are being detected; on the other hand, the numbers cured by MDT have soared from 55,000 in 1985 to 7.4 million in 1997, while the registered cases have fallen from 2.9 million in 1985 to 640,000 in 1997.
As part of the series commemorating W.H.O.'s 50th. anniversary this year, the Regional Office in New Delhi has published an information kit summing up the situation and painting a generally optimistic picture. Thus, despite the high numbers affected, Bangladesh, India, Myanmar and Nepal still hope to eliminate leprosy by the end of the millennium. Sri Lanka and Thailand achieved elimination in 1994, and Bhutan, Indonesia and Maldives hope to reach the goal this year. No cases have been reported from DPR Korea. The document shows that some of the innovative approaches that are being tried in different countries aimed at overcoming specific hazards in the path of elimination. Many are finding ways to improve MDT supply, to integrate leprosy activities into the general health services and to work more closely with NGO's in the field. Leprosy is no longer the concern of governments or the health community alone - it is everyone's concern, requiring a multisectoral effort."
PLEASE NOTE THAT THE W.H.O's WORD "ELIMINATION" MEANS BRINGING THE PREVALENCE RATE OF THE DISEASE DOWN BELOW ONE CASE IN 10,000 POPULATION, WHEN LEPOPSY WILL NO LONGER BE CONSIDERED A PUBLIC HEALTH PROBLEM. Leprosy will still be around, well into the 21st. century, and even after it has been "ELIMINATED", but in such areas, it will not be considered a public health PROBLEM, and cases will be treated in general public health clinics. When all traces of M.leprae bacilli and the conditions affecting those infected by the bacillus have been removed from present endemic areas, W.H.O. will start using the word "ERADICATION" . Until we can be sure that H.D. has been "ERADICATED", we must continue to remain vigilant.
Public Health Personnel are being advised to learn all they can about Hansen's Disease (leprosy) , especially how to diagnose the disease and be able to differentially diagnose it in light of the fact that there are about 30 odd conditions which can be confused with early and late H.D.. Also, the Management of leprosy Reactional States need to be properly controlled to prevent nerve damage and this requires specialist training.
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